Attachment L-Revised: COVID-19 Short-Term Survey Sources

Attachment L_Revised COVID-19 Cohort Short-Term Survey Souces.docx

OPRE Evaluation - National and Tribal Evaluation of the 2nd Generation of the Health Profession Opportunity Grants [descriptive evaluation, impact evaluation, cost-benefit analysis study, pilot study]

Attachment L-Revised: COVID-19 Short-Term Survey Sources

OMB: 0970-0462

Document [docx]
Download: docx | pdf



Attachment L-Revised: COVID-19 Cohort Short-term Survey Question Sources

            1. #
            1. Domain/Topic
            1. Sources
  1. Training and Employment History

A1

Job or school status at RAD

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Minor modifications.

A2

Other activities at RAD

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A3

Any job or school spells since RAD

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A4

If respondent had any job or school spell since RAD, which did they do first

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A5

Reasons for not working since RAD

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A6

Reasons for not going to school during gaps

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A7a and A7b

Dropped


Main” Activity Spell Details

A8 and A8a



A8_1

Employer name and self-employment/School name



School address (street, cross-street, and city)

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

New

A9-A9a

Spell start date


HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Modified to capture year and season if date unknown.

A10, A10a, and A10b

Spell end date

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Modified to capture year and season if date unknown; captures total time spent in that activity if season and year are unknown.

A11

Full or Part time Status

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Modified for school spells to capture hours of attendance as opposed to full or part time enrollment.

A12a and A12b

Dropped


A13-A14

Next activity after current spell ended

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A15

Did respondent ever work or go to school again?

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A16

Did respondent work or go to school first?

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A17

Identification of overlapping job spell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A18

Identification of overlapping school spell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A19

Main activity during gap period (3+ months between work and/or school spells)

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A20

Current employment status

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A21

Employed since last job spell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

Subspell” Activity Details

A22

Employer or School name

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A23 and A23a

Start date for this subspell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Modified to capture year and season if date unknown.

A24, A24a, A24b

End date for this subspell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Modified to capture year and season if date unknown; captures total time spent in that activity if year and season are unknown.

A25

Working in same field as course of study

New.


Additional jobs worked or schools attended during this subspell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

A26.

Working in a job within a job, job within a school or school within job spell.

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).


Additional schools attended during this subspell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

  1. School Experiences

B1

Gaps in training for 4 weeks or more

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397). Minor modifications.

B1a

Number of 4 week gaps during this school spell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B1b

Date stopped classes

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B1c

Date resumed classes

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B2

Participation in basic education classes

PACE 15-month Follow-Up Survey (OMB No. 0970-0397). Minor modifications to capture for each spell.

B2a

Completion of basic education classes

PACE 15-month Follow-Up Survey (OMB No. 0970-0397). Minor modifications to capture multiple spells.

B2b

Did classes help prepare for enrollment in regular college?

New

B3-B3a

Receipt of college credits

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B3b-c

Verification of college credits earned

New

B4

Completion status of for each spell

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B5

Dropped


B6a-k

Dropped


B7

Dropped


B8

Dropped


B9

Student Loan Respondent Debt

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B9a

Student Loan Respondent Debt

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B10

Student Loan Family Debt

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B10a

Student Loan Family Debt

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

B11a-j

Dropped


B12

Difficulty finding support to attend classes

PACE 15-month Follow-Up Survey (OMB No. 0970-0397).

B13

Services received from school

PACE 15-month Follow-Up Survey (OMB No. 0970-0397).

B14

B14a

Time spent in one-on-one service receipt

New

B15

B15a

Time spent in group service sessions

New

B16a-f

Participation in occupation related activities

PACE 15-month Follow-Up Survey (OMB No. 0970-0397).

B17


Participation in classes or counseling sessions on work-related behaviors

Job Search Assistance Strategies Evaluation 6-month Follow-up survey (OMB No. 0970-0440). Minor modifications.

B18

B18a

Dropped


B19

Engagement (Dropped B19b and B19c)

University of North Dakota’s Student Evaluation of Learning and Feedback for Instructors (SELFI). Minor modifications.

B20

Individual rapport (Dropped B20a and B20c)

University of North Dakota’s Student Evaluation of Learning and Feedback for Instructors (SELFI). Minor modifications.

B21

Organization and clarity (Dropped B21a and B21c)

University of North Dakota’s Student Evaluation of Learning and Feedback for Instructors (SELFI). Minor modifications.

B22

Dropped


B22

Dropped


B22

Dropped


B24

Dropped


  1. Credentials

C1-C1b

Were courses taken to prepare for work in particular occupation? Was that occupation healthcare related?

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

C1c-C1e

Currently working in this occupation? (C1d dropped)

PACE 15-month Follow-Up Survey (OMB No. 0970-0397).

C2-C2f

Academic degrees or diplomas receipt

C2, 2a, 2c-f: PACE 15- and 36- and 72-Month Follow-Up Surveys (OMB No. 0970-0397). Original sources: based on the Green Jobs 15-Month Follow-Up Survey (OMB No. 1205-0481NOA), the 2005 National Household Education Survey (OMB No. 1850-0768), and the National Community College Survey of Student Engagement (CCSSE).


C2b: Adult Training and Education Survey, Part of the 2016 National Household Education Survey (OMB No. 1850-0768).

C3 – C3h


Academic certificate receipt

C3-a-c: PACE 15- and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Modified to follow the format of the Adult Training and Education Survey, Part of the 2016 National Household Education Survey (OMB No. 1850-0768).


C3d, 3f: PACE 15-and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Original sources: based on the Green Jobs 15-Month Follow-Up Survey (OMB No. 1205-0481NOA), the 2005 National Household Education Survey (OMB No. 1850-0768), and the National Community College Survey of Student Engagement (CCSSE).


C3e, C3h: PACE 15- 36-, and 72-Month Follow-Up Surveys (OMB No. 0970-0397).


C3g: Adult Training and Education Survey, Part of the 2016 National Household Education Survey (OMB No. 1850-0768).

C4-C4f











Professional certification or state/industry license receipt

C4: PACE 15- and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Modified to include introductory text to follow format of the Adult Training and Education Survey , Part of the 2016 National Household Education Survey (OMB No. 1850-0768)


C4a, C4f: HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (OMB No. 0970-0397).


C4b, C4d, and 4e: PACE 15- and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Original sources: based on the Green Jobs 15-Month Follow-Up Survey (OMB No. 1205-0481NOA), the 2005 National Household Education Survey (OMB No. 1850-0768), and the National Community College Survey of Student Engagement (CCSSE).


C4c: Adult Training and Education Survey, Part of the 2016 National Household Education Survey (OMB No. 1850-0768).

C5


Work-based training

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397). Original source Adult Training and Education Survey, Part of the 2016 National Household Education Survey (OMB No. 1850-0768). Modified to capture any work-based training, not most recent one.

C6



Type of work-based training

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397). Original source Adult Training and Education Survey, Part of the 2016 National Household Education Survey (OMB No. 1850-0768). Modified to capture any work-based training, not most recent one.

C7


Employer-provided training

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397). Original source Education Longitudinal Study (OMB No. 1850-0652). Modified to eliminate 12-month time frame.

C8a


Progress toward long-range education goals

PACE 15- and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Original sources: based on the Green Jobs 15-Month Follow-Up Survey (OMB No. 1205-0481NOA) and the 2005 National Household Education Survey (OMB No. 1850-0768).

C8b-c

Self-perception of career track progress

PACE and HPOG 15-and 36-Month Follow-Up Surveys (OMB No. 0970-0397; OMB No. 0970-0394).

C9

Knowledge of additional training needs to advance in career

New.

C10

Plans to pursue training for next level of occupation

New.

  1. Current / Most Recent Job

D1-2a


Industry

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397). Original source American Community Survey (OMB No. 0607-0810 and OMB No. 0607-0936).

D3


Occupation

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397). Original source the American Community Survey (OMB No. 0607-0810 and OMB No. 0607-0936).

D4


Job activities

PACE 15- and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Original source the American Community Survey (OMB No. 0607-0810 and OMB No. 0607-0936).

D5


Job title

PACE 15- and 36-Month Follow-Up Surveys (OMB No. 0970-0397). Original source the American Community Survey (OMB No. 0607-0810 and OMB No. 0607-0936).

D6

Occupation related to healthcare

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394).

D7- D7c

Job pay (hourly earnings/weekly pay for self-employed)

HPOG 36 and 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Survey (0970-0397).

D8- D8c

Requirement for shift work

7 and 7a: PACE and HPOG 15- 36- and 72-Month Follow-Up Surveys (OMB No. 0970-0397; OMB No. 0970-0394).Originally taken n from Green Jobs 15-Month Follow-Up Survey (OMB No. 1205-0481NOA).


7b: PACE and HPOG 72-Month Follow-Up Surveys (OMB No. 0970-0397/0970-0394).


7c: New

D9a-c

Job flexibility (hours and schedules)

8a: HPOG 36- and 72-month Follow-Up Surveys (OMB No. 0970-0394). Originally modified question from the Education Longitudinal Study (OMB No. 1850-0652). Modified to change scale from numeric ranking to level of agreement.


8b-c: HPOG 36-and 72-month Follow-Up Surveys (OMB No. 0970-0394).

D10

Available benefits

HPOG 72-month Follow-Up Survey (OMB No. 0970-0394). Originally a modified question from Green Jobs 15-Month Follow-Up Survey (OMB No. 1205-0481NOA). Modified to eliminate follow-up sub-items. Added item to capture personal time off, also referred to as earned time or paid time off.

D11


Quality of work life

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 72-month Follow-Up Survey (OMB No. 0970-0397).

D12-D14


Self-perception of opportunities for career advancement

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397).). Original source: Project Quest 6-Year Follow-Up Survey (the evaluation of Project Quest is being conducted by the Economic Mobility Corporation with a grant from the Charles Stuart Mott Foundation).

D15

Employer provided financial support for education and training

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397).

D16

Employer provided non-financial support for education and training

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397).

  1. Household Composition

E1

Household composition including marital status

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Original sources: Slight modification of American Community Survey (ACS) and the Supporting Healthy Marriages (SHM) baseline (OMB No. 0970-0299).

E2

How long respondent has been married or living with a romantic partner

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397).

E2a

Regular interaction with spouse or romantic partner

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397). Original source Supporting Healthy Marriages (SHM) baseline (OMB No. 0970-0299). Modified to shift focus from frequency that they saw each other to frequency they discussed daily life with one another.

E2b

Ever been married or lived with a romantic partner during follow-up period

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397).

E3

Number of adults in the household

HPOG 72-Month Follow-up Survey (OMB No. 0970-0394)/PACE 72-Month Follow-up Survey (0970-0397).

E4

Number of children in the household

HPOG 15-, 36-, and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 15-, 36-, and 72-Month Follow-up Surveys (0970-0397). Original source: based on the Supporting Healthy Marriages (SHM) baseline (OMB No. 0970-0299).

E5

Number of dependents in the household

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Original source: Employment, Retention, Advancement (ERA) Study (OMB No. 0970-0285). Modified 36-month language to shift from legal guardian to primary caregiver.

E6

Current fertility

PACE 15-, 36-, and 72-Month Follow-up Surveys (0970-0397). Modified wording for male respondents.

E7

Recent fertility

PACE 15-, 36-, and 72-Month Follow-up Surveys (0970-0397). Modified wording for male respondents.

E8

E9

Dropped

Dropped


  1. Income and Adult Well Being

F1



Receipt of public benefits

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Original source: Supporting Healthy Marriages (SHM) baseline (OMB No. 0970-0299). Modified to ask for respondent and other household members in same question rather than separately and to revise child support question.

F2


Total personal income in prior month

HPOG 15-, 36-, and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 15-, 36-, and 72-Month Follow-up Surveys (0970-0397). Original sources: based on the PACE Baseline intake form (BIF) (OMB No. 0970–0343).

F3

Total household income in prior month

HPOG 15-, 36-, and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 15-, 36-, and 72-Month Follow-up Surveys (0970-0397). Original sources: based on the PACE BIF (OMB No. 0970–0343).

F4

EITC

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397).

F5

Dropped


F6

Dropped


F7

Total debt

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397).

F8


Material hardship

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Original source was modified question from Assets for Independence (AFI) Experiment: 12-Month Follow-Up Survey (OMB No. 0970-0414).

F9

Hunger, food insecurity

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Original source was exact question from Assets for Independence (AFI) Experiment 12-Month Follow-Up Survey (OMB No. 0970-0414).

F10

Making ends meet

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397) Original source was from PACE 15-Month Follow-Up Survey (OMB No. 0970-0397) and based on the PACE Self-administered questionnaire (SAQ (OMB No. 0970–0343).

F11-12


Dropped F11

Ability to meet emergency expenses

Survey on Household Economics and Decision-Making (OMB No. 7100-0359).

F13-14


Health Insurance through employer or non-employer

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Modified to first capture whether those employed have insurance through employer and whether those unemployed have insurance through another source.

F15


Current housing

HPOG 36- and 72-Month Follow-up Surveys (OMB No. 0970-0394)/PACE 36- and 72-Month Follow-up Surveys (0970-0397). Original source Moving to Opportunity (MTO) Adult Survey (OMB No. 2528-0218).

F16-F16a


Whether respondent was doubled-up or living with friends or relatives and if so, for how long

Family Options Study 36-Month Follow-Up Survey (OMB No. 2528-0259).

F17

Physical health

National Health and Nutrition Examination Survey (OMB No. 0920-0237).

F18

Life Challenges


  1. 21st Century Skills/Cognitive Skills

G1

Computer skills utilization in everyday life

PIAAC Background Questionnaire (OMB Control No. 1850-0870). Modified to include only a subset of items.

G2

Literacy skills utilization in everyday life

PIAAC Background Questionnaire (OMB Control No. 1850-0870). Modified to include only a subset of items.

G3

Dropped


G4

Self-directed learning

New

G5

Self-directed learning

New

  1. Contact Information

H1 – H12

Respondent and Secondary Contact Information

HPOG 36-month Follow-Up Survey (OMB No. 0970-0394)/PACE 36-month Follow-Up Survey (OMB No. 0970-0397).

  1. COVID-19 Module


I1

Desire to work in healthcare post-COVID-19

HPOG 2.0 Intermediate Follow-up Survey

I2

Desire to continue healthcare training post-COVID-19

HPOG 2.0 Intermediate Follow-up Survey

I3

COVID-19 Effect on education and training

HPOG 2.0 Intermediate Follow-up Survey

I4

Provision of direct care and setting

Epidemic Pandemic Impact Inventory- (EPII) Modified

14b

Adequacy of PPE

EPII-Modified

I5

Effect of COVID-19 on quality of life

I5a, b, c, and e: NEW

I5d,and f EPII-Modified

I6

Post-COVID financial resiliency

HPOG 2.0 Short-term Follow-up Survey-Modified



pg. 8

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleAbt Single-Sided Body Template
AuthorMissy Robinson
File Modified0000-00-00
File Created2021-12-08

© 2024 OMB.report | Privacy Policy